Editor’s note: Jerusha Murugen is the research associate for global health, economics, and development at the Council on Foreign Relations. You can follow her @Jerusha_Murugen. The views expressed are her own.

In the midst of a bloody civil war, the biggest killer in Syria may not be the one you expect: chronic disease.

For many thousands of Syrians who struggle to access medical treatment in a war with no end in sight, everyday medical conditions have now become a matter of life or death. Dr. Zaher Sahloul, president of the Syrian American Medical Society (SAMS), estimates that as many as 200,000 Syrians have died from chronic conditions, such as cancer, diabetes, hypertension, and respiratory and heart conditions, as a result of lack of access to drugs and treatment, double the number of Syrians killed by combat operations.

This stands in contrast to the situation prior to the conflict, when many Syrians received consistent care for these illnesses, with such treatment accounting for a significant portion of Syria’s health services. The United Nations now estimates that over half a million Syrians will require chronic disease treatment for the remainder of 2013. Of this figure, more than 400,000 Syrians alone are expected to require diabetic care.

And while daily atrocities and war crimes have gained international attention, most recently August’s horrific chemical weapons attack, Médecins Sans Frontières, an international non-governmental organization providing medical care in Syria, stresses that victims who survive combat operations more frequently become “silent casualties,” succumbing instead to previously manageable chronic illnesses as a result of calculated attacks on Syria’s primary health care system and pharmaceutical industry.

Syria was once known for its established health care system and cadre of domestically-trained medical workers. Indeed, with a constitution sanctioning comprehensive public health services, its health ministry provided virtually free medical treatment to the Syrian public. Syria had its own drug industry, producing 90 percent of its medicines. It was also the second-largest pharmaceutical manufacturer in the region, exporting medicines to over 50 countries. As a result of this strong health care infrastructure, Syria had health indicators comparable to high-income countries, with an estimated life expectancy of 76 years.

But over the last two years, Syria’s health care system has undergone a tragic transformation. Continued assaults on hospitals and medical providers have resulted in parts of Syria experiencing as much as a 70 percent decrease in health personnel. The World Health Organization (WHO) estimates that 20 percent of Syrian public hospitals have been damaged and 37 percent are now inoperable. Ambulance services have weakened dramatically, with nearly 80 percent of vehicles damaged and over 50 percent disabled. Its once flourishing drug industry has suffered a 90 percent production decline in the pharmaceutical capitals of Rural Damascus and Aleppo, sites of intense combat.

Today, accessing medical care can be a life-threating endeavor for Syrians. Those willing to venture out face traveling in a war zone and navigating numerous military and discordant rebel checkpoints. Patients seeking treatment do so with the understanding that health facilities may come under attack at any moment. Its pharmaceutical industry faces numerous hurdles as well, including shipping across the country, importing raw materials, and denial of credit by foreign banks for such purchases.

As a result, of all this, Syrians are now facing a critical shortage of medicines, particularly for chronic illnesses – WHO surveys indicate that basic supplies, such as insulin for Syria’s 40,000 juvenile diabetes patients, are no longer available. Residents face frequent pharmacy stock outs or more simply cannot afford available medicines. Given these conditions, the Union of Syrian Medical Relief Organisations (UOSSM), a Paris-based NGO, estimates that 70,000 cancer and 5,000 dialysis patients are not receiving the treatment they need.

While international organizations are providing medical aid in the country, the Syrian government has issued stringent policies for such groups, authorizing only Syrian government-approved domestic and international organizations to work in the country. Such organizations are also explicitly prohibited from delivering aid from one country into another, a practice commonly termed “cross-border aid.”

U.N. aid deliveries are also tightly controlled. Official aid must be routed from government-controlled Damascus, from where it is closely monitored as it travels through government checkpoints. U.N. agencies have been further restricted, with reports of soldiers at checkpoints removing most or all WHO supplies before reaching opposition-held areas or flatly denying medical deliveries.

In response to these obstacles, this month more than fifty leading medical physicians, including Nobel Prize laureates and heads of major medical organizations, issued an open letter to all parties involved in the conflict requesting unimpeded access, cross-border and otherwise, to allow for critical medical treatment to Syrians caught in the cross-hairs of war, in the esteemed global health journal The Lancet.

Circumventing Syrian government-controlled U.N. routes, most medical aid now filters through Turkey to opposition-held northern Syria. MSF, one aid group illegally providing medical care in the area, has reported a high demand for diabetes and hypertension treatment yet limited medical supplies arriving from Damascus.

Though the United Nations will not violate the Syrian government’s sovereignty, other entities, such as SAMS and the UOSSM, are willing to provide aid from international borders. The French government has previously donated medical supplies, including heart medications, through UOSSM. This group has delivered and distributed such aid from Turkey to Syria, providing critical drugs to thousands of Syrians. Efforts like these should be scaled up, with international pharmaceutical companies and governments donating specific medicines to NGOs willing to engage in cross-border assistance.

While finding a solution to Syria’s civil war will continue to be difficult, resolving its chronic disease crisis should not be. With the United Nation’s hands effectively tied, other actors must now act where the international community cannot.

soundoff(30 Responses)

George patton

We Americans sorely need to quit our bullying tactics and drop our idiotic demand that Bashar al-Assad steps down. This is an embarrassment to this country and is only serving to prolong that country's civil war which in turn is leading to all kinds of misery for the Syrian people. This civil war needs to end!

It is easy for you to say, it is not your blood which was shed nor your kids which were buried. If the the US wants to stand with the dictator and submit to Russian demands, then it is a US decision and it can't be imposed on Syrians anymore. The dictator will fall comes hell or high water

I disagree, SA. These so-called "rebels" or the Syrian "Free" Army seek to reduce Syria to no more the a U.S. satellite state like Iraq and Afghanistan where these U.S. backed pseudo-democracies are not working out too well, especially in Iraq where terrorist attacks occur almost on a daily basis. Like George said above, we need to pick up our marbles and get out of the Middle East once and for all!

October 1, 2013 at 11:21 am |

saywhat

The so called 'rebels', mostly foreign fighters with elements of AlQaeda leading them trained by Israel and armed by S.Arabia/CIA would be the undoing of Syria.We are already witnessing the beginnings of parallel disintegration of Iraq & Syria. These rebels have not been lagging behind in mass killings and human rights violations.

November 1, 2013 at 12:08 pm |

saywhat

Israeli factor in Syrian disaster is no longer a secret. A couple of months back ex-French foreign minister Dumas revealed to a french TV that Israel had planned Syrian implosion months before 'Arab Spring' inducting 'rebels' into the territory. A part of their 'Oded Yinon Greater Israel'plan.S.Arabia is on board for their own reasons.

Foreign interventions in the region have played havoc, death, destruction, unending cycle of violence and spread of extremism is what we are seeing.
And now the McCains, Grahams and their ilk up on the Hill are pushing for a war with Iran. These dual loyalty law makers most certainly are not for American interests.

It's so tragic, the plight of the Syrians, caught between fighting between regime forces and the opposition. Indeed, the death tolls may be higher, if one considers those, who die of diseases and medical negligence. Yes, the Assad regime provided for free health services, but the price was high for these benefits.

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